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INTERNAL INVESTIGATION: This probe was used, unsuccessfully, to locate the bullet lodged in President Garfield’s body following the assassination attempt in 1881. Courtesy of the Warren Anatomical Museum at the Francis A. Countway Library of Medicine.

Physicians in battle zones have always had to make do with difficult working conditions to treat wounds, often achieving stunning results, and sometimes making long-lasting contributions to medical knowledge.

The challenging conditions of this nation’s Civil War, for example, yielded several now-standard medical procedures. Notorious for poor supply chains, a dearth of trained medical personnel, and massive casualties, this war nevertheless produced the foundations of a triage system for trauma care, the routine use of anesthetics, the beginnings of the use of sanitary practices such as handwashing, and the discovery that shock was a condition that needed specialized treatment.

MUTE TESTIMONY: Objects associated with injuries acquired in violent acts include, clockwise, from top left, a femur with a bullet lodged in the diaphysis (willed to the Boston Society of Natural History by Jeffries Wyman, Class of 1837); a skull fragment from a Civil War veteran, with bullet embedded; and a set of three facial moulages, made during World War I by Varaztad Kazanjian, Class of 1921, showing the progress of reconstruction and recovery of a British soldier who lost his mandible in an explosion.
Facial moulages courtesy of the Harvard Medical Library at the Francis A. Countway Library of Medicine. Other items courtesy of the Warren Anatomical Museum at the Francis A. Countway Library of Medicine.

During World War I, necessity again propelled innovation, as the severity of injuries kept pace with modern weaponry. Triage evolved to favor first treating patients with critical but less complicated wounds over those with the most severe injuries. Other advances included the use of splints to immobilize fractured femurs and the use of ligature to help stanch bleeding from gunshot wounds. While no one would say that war provides an ideal classroom, physicians, in their quest to save lives and limbs, have used it to learn how to care for the wounded in new, and lasting, ways.